Primary Prevention Of Macrovascular Diseases In Patients With Short-duration Type 2 Diabetes Mellitus By Intensified Multifactorial Intervention

Objective:To compare Primary prevention of macrovascular diseases by intensified multifactorial intervention with conventional intervention in patients with short-duration type 2 diabetes mellitus(T2DM).Methods:131 patients with T2DM, including 66 men and 65 women,were enroll. The 131 patients were randomized into intensive multifactorial intervention group (intensive group) with 106 patients and conventional intervention group (conventional group) with 25 patients. For intensive group, physical examination and fast plasma glucose were measured monthly. Glycated hemoglobin A1c (HbA1c), blood lipid, serum creatinine and ALT were measured every six months, common carotid artery IMT (CC-IMT) and ECG were preformed yearly. Hypoglycemic therapy was adjusted according to regular monitoring of FPG and HbAlc, with the targets of 7.0mmol/L and 7.0% respectively. Blood pressure control followed a similar stepwise approach to a target of 130/85 mmHg.TC was controlled within 4.66mmol/L, TG within 1.7mmol/L and LDL-C within 2.6 mmol/L. For conventional group, loose outpatient management was prefo-rmed without intensive intervention target and free drugs were unavailable. Related research indexes were measured each year for free. The mean follow-up was 7 years.Results:1. Compared with conventional group, at end of 7 years intervention, HbA1c were decreased in both intensive group and conventional group. But HbA1c in intensive group were decreased significantly(P<0.05). Between the two groups after intervention, FPG were significantly reduced in intensive group than in the conventional group (P<0.05).2. In both intensive group and conventional group systolic pressure (SBP)and diastolic pressure(DBP) were decreased, while DBP in intensive group were decreased significantly(P<0.05). Between the two groups after intervention, SBP,DBP were significantly reduced in intensive group than in the conventional group (P<0.05).3. TC and TG were significantly reduced in intensive group than in the conventional group after intervention(P<0.05). Although LDL-C were a little reduced,there was no significantly difference between two groups(P >0.05).4. The number of patients with artery IMT>1.0 mm and/or AS plaques in carotid artery and/or other outcomes in intensive group were 15 and the morbidity rate was 17.44%. At the same time,in the conventional group,the number was 10 and the morbidity rate was 50%.The difference was signi-ficantly between the two groups (P<0.05).Conclusions:1. Our study suggests that intensified multifactorial intervention can produce a marked effect in primary prevention of macrovascular diseases in patients with T2DM.2. The clinical manifestations which have occurred can not serve as an early indicator of cardiovascular events, thickening of common carotid intima-media is considered as a major marker of early stage atherosclerosis.3. The target of HbA1c in our test is 7.0% and primary prevention of macrovascular diseases can be obtained, suggesting that we do not need too strict to HbA1c control.